Source: DGNews  |  Posted 1 year ago

BETHESDA, Md -- September 3, 2010 -- On average, a lower blood pressure goal was no better than the standard blood pressure goal at slowing progression of kidney disease among African-Americans who had chronic kidney disease (CKD) resulting from high blood pressure.

However, the blood pressure goal did benefit people who also had protein in the urine, which is a sign of kidney damage.

These are the results of the African-American Study of Kidney Disease and Hypertension (AASK) published in the September 2 issue of the New England Journal of Medicine.

The AASK also found that among people with protein in their urine, keeping blood pressure at the lower level reduced the likelihood of kidney disease progression, kidney failure or death by 27% compared with the standard blood pressure level.

"For some patients, more intensive control of blood pressure may slow progression of chronic kidney disease," said Griffin P. Rodgers, MD, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, Maryland. "Rigorous, long-term studies like the AASK remain critically important for improving treatment of CKD and other diseases that develop over time, as it can take years for benefits of treatment to emerge."

AASK adds new information about which patients with CKD benefit from lowering of blood pressure. This information may help doctors practice evidence-based, personalised medicine, the tailoring of each treatment regimen to each patient's unique characteristics.

AASK followed participants for approximately 12 years to measure the long-term effects of blood pressure control in African-Americans with kidney disease attributed to high blood pressure.

The study was conducted in 2 phases. First, in a clinical trial from 1995 to 1998, participants were randomly assigned to a standard blood pressure goal of roughly 140/90 mmHg or a lower goal of less than 130/80 mmHg. After the clinical trial was completed, most of the remaining participants were enrolled in a follow-up study in which everyone had a blood pressure goal of less than 130/80 mm/Hg.

"The AASK study is the largest and longest study of kidney disease in African-Americans," said Lawrence Appel, MD, Johns Hopkins University, Baltimore, Maryland. "It is a landmark study that is paying off -- guiding patient care and improving health outcomes. This study also highlights the importance of conducting long-term clinical studies. Without the follow-up study, the benefits of the lower goal would have been missed.

Study participants were initially recruited beginning in 1995 for the AASK Clinical Trial. Patients with diabetes and some other serious health problems were excluded. After the conclusion of that study, AASK participants who had not yet developed ESRD were invited to participate in the AASK follow-up study, which started in 2002.

In the follow-up study, recommended blood pressure therapy started with an angiotensin converting enzyme (ACE) inhibitor. If blood pressure was not controlled, additional drugs were added. On average, patients needed about 3.5 medications for blood pressure each day.

SOURCE: The National Institutes of Health